Ping Yi, Gu Huahua
Department of Anesthesiology, Huashan Hospital Fudan University, Shanghai, China.
Medicine (Baltimore). 2018 Nov;97(48):e13320. doi: 10.1097/MD.0000000000013320.
Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries.
A 46-year-old man came to our hospital with intermittent right-side headache for 5 years, and left lower limb numbness for 3 months.
Magnetic resonance imaging (MRI) of the head and digital subtraction angiography confirmed the diagnosis of right middle cerebral artery (MCA) aneurysm.
Considering the large size of this MCA aneurysm, RVP was used to reduce blood pressure during MCA aneurysm repair, and to lower the risk of intracranial hemorrhage during procedure.
Post procedure, there was no abnormality detected. Seven weeks after surgery, the patient's muscle tone of right side extremities were grade V and left side extremities were grade IV. Computed tomography angiography confirmed no MCA aneurysm.
In cases of aneurysm rupture, RVP will induce a transient "very low pressure" condition, and give a valuable time frame to clip the ruptured aneurysm. Therefore RVP is a safe and effective method to provide transient reduction of cardiac output in intracranial aneurysm patients.
脑动脉瘤是颅内出血、中风和死亡的常见原因。它通过血管手术进行治疗，如线圈栓塞和动脉夹闭术。然而，手术本身是一个危险因素，可能导致动脉瘤破裂，进而导致不可逆的脑损伤，甚至死亡。快速心室起搏（RVP）是一种通过增加心率和减少心室充盈时间来暂时降低血压的操作。RVP已广泛应用于许多心血管手术中以降低血管张力。
一名46岁男性因间歇性右侧头痛5年、左下肢麻木3个月前来我院就诊。
头部磁共振成像（MRI）和数字减影血管造影确诊为右大脑中动脉（MCA）动脉瘤。
考虑到该MCA动脉瘤体积较大，在MCA动脉瘤修复过程中使用RVP来降低血压，并降低手术期间颅内出血的风险。
术后未检测到异常。术后7周，患者右侧肢体肌张力为V级，左侧肢体肌张力为IV级。计算机断层扫描血管造影证实无MCA动脉瘤。
在动脉瘤破裂的情况下，RVP将诱导短暂的“极低血压”状态，并为夹闭破裂的动脉瘤提供宝贵的时间框架。因此，RVP是一种在颅内动脉瘤患者中安全有效地短暂降低心输出量的方法。
